Birthmarks

A birthmark is a mark on the skin present at birth or appearing in the weeks afterwards. They fall into two broad groups - vascular and pigmented - and the group a birthmark belongs to determines almost everything about whether and how it can be treated.

Most birthmarks are harmless and need no treatment at all. People seek treatment because of appearance, particularly on the face, or because a birthmark is causing a functional problem.

Vascular birthmarks

Caused by blood vessels that are extra, enlarged or abnormally formed.

• Salmon patch (stork mark, angel's kiss) - flat pink patches on the eyelids, forehead or nape. Very common. Those on the face usually fade in the first year or two.
• Infantile haemangioma (strawberry mark) - a raised red lesion that typically grows for the first few months, then shrinks over years. Many need no treatment. Those near the eye, airway, nose or lip, or those ulcerating, need paediatric assessment early. See haemangiomas.
• Port wine stain (capillary malformation) - a flat pink to deep red or purple patch, often on the face. Unlike haemangiomas, port wine stains do not fade; they persist and tend to darken and thicken over decades.

Pigmented birthmarks

Caused by clusters of pigment-producing cells.

• Congenital melanocytic naevus - a brown or black mole present at birth, from small to very large. Large congenital naevi carry a higher melanoma risk than ordinary moles and warrant ongoing specialist monitoring.
• Cafe-au-lait macule - a flat, evenly coloured light-brown patch. One or two are common and unremarkable; six or more warrant a medical review, as they can be associated with underlying conditions.
• Mongolian spot (dermal melanocytosis) - blue-grey patches, usually over the lower back and buttocks, common in babies with darker skin. They usually fade in childhood and need no treatment.
• Naevus of Ota - blue-grey pigmentation around the eye and temple.

Assessment first

Before treatment, the birthmark is examined and the type established. This matters because:

• Some vascular birthmarks need paediatric or specialist care, not cosmetic treatment
• Some pigmented birthmarks need ongoing surveillance for melanoma - and destroying such a lesion with laser removes the ability to monitor or test it
• Laser suited to a vascular lesion is the wrong device for a pigmented one
• A few birthmarks are associated with underlying conditions that should be identified

Where a pigmented lesion needs a diagnosis, it is excised whole and sent to pathology rather than lasered. See skin cancers.

Treatment options

Vascular birthmarks

Vascular lasers and light-based treatments target haemoglobin in the vessels. Port wine stains are typically treated over a long course of sessions, often beginning in childhood, and respond best when treated early. IPL and Nd:YAG are used depending on the lesion. See laser treatments.

Pigmented birthmarks

Pigment-targeting lasers can lighten some pigmented birthmarks. Response varies substantially with the depth of pigment - superficial pigment responds far better than deep. Surgical excision is used for some lesions, particularly where a diagnosis is needed or the lesion is raised, and leaves a scar in place of the birthmark.

Camouflage

Mineral make-up and medical camouflage cover a birthmark without altering the skin. For some people this is the better answer, and it is a legitimate choice rather than a fallback.

What results are realistic

This is the part worth being direct about. Most birthmarks lighten with treatment; few disappear.

• Port wine stains typically lighten significantly over many sessions, and commonly need maintenance because they re-darken over years
• Superficial pigmented birthmarks often respond well; deep pigment often does not
• Excision trades the birthmark for a scar - which may be a good trade, but is a trade
• Results vary between people and between birthmarks of the same type

Anyone promising complete removal of a birthmark is overstating what these treatments do. You should be told, before you commit, what degree of change is realistic in your case.

Risks

• Redness, swelling, bruising and crusting after laser
• Blistering
• Changes in pigmentation, lighter or darker, which can be permanent
• Scarring
• Infection
• Incomplete response
• Re-darkening or recurrence over time
• Higher risk of pigment change in darker skin types

See risks and complications.

Children

Birthmark treatment in children is a specialist area. Infants with haemangiomas near the eye, nose, mouth or airway, or with large or ulcerating lesions, should be seen by a paediatric specialist. We will refer rather than treat where that is the right pathway.

Cost

As at September 2024 and including GST, a skin assessment is $50 and a Cosmetic Doctor consultation is $150. A course of laser is quoted after assessment. Cosmetic treatment is not covered by Medicare; treatment that is medically indicated may attract a rebate.

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form.

Related: haemangiomas, hyper-pigmentation, mole removal, all skin conditions.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.